Tuesday, February 28, 2006

Reputation Plays a Vital Role in Influencing a Patient's Choice of Hospital

From JD Power:

Patient perceptions of a hospital's reputation play an important role in hospital selection, according to the J.D. Power Associates 2005 National Hospital Service Performance StudySM. The study, which was based on responses from 2,500 patients who stayed in a hospital for at least one night within the previous three to nine months of being surveyed, found that three-fourths of patients used reputation-related information as their primary criteria in selecting a hospital.

Nearly one-half (48 percent) of patients said that the hospital's overall reputation was their primary criterion for selection, while 25 percent said the availability of good doctors and having skilled nurses on staff was most important in their selection.

The study measured overall patient satisfaction in five categories: dignity and respect; speed and efficiency; comfort; information and communication; and emotional support. Patients overall were very satisfied with the service they received during their most recent hospital stay, with 74 percent of patients giving the hospital high ratings regarding their hospital experience. Hospitals received the highest ratings from patients in the area of dignity and respect. Conversely, patients have consistently given hospitals the lowest ratings for speed and efficiency, with only 36 percent of patients indicating they were delighted.

Saturday, February 25, 2006

Contract Negotiations in Olympia

From The Olympian (WA):

About 21,000 state employees and dependents in Thurston County will be warned by mail today that their Uniform Medical Plan insurance won’t cover as much of the cost as it previously did for an emergency room visit at Providence St. Peter Hospital.

At issue is a breakdown in contract talks between the state Health Care Authority, which administers the Uniform Medical Plan, and a group of physicians who staff the Olympia hospital’s emergency room under a separate contract with the hospital.

Because the insurance agreement lapsed Dec. 31 and no new “network” or preferred provider contract has been set, patients could find they’re charged more than would be allowed under the agreement Uniform Medical Plan previously had with the doctors, state officials said Thursday.

Wednesday, February 22, 2006

Patient's impatience lands her in rubble

From the Philadelphia Daily News:

A Florida woman sought treatment at a New Jersey hospital's emergency room over the weekend but apparently didn't like the service.

Police said she didn't wait long enough and didn't wait properly.

But the woman apparently had a second opinion, because she abruptly left the hospital's emergency room, got into her Buick sport utility vehicle and smashed it through the front entrance and into the lobby.

A.M.A. to Develop Measure of Quality of Medical Care

From the New York Times:

The American Medical Association has signed a pact with Congress promising to develop more than 100 standard measures of performance, which doctors will report to the federal government in an effort to improve the quality of care.

The deal comes as the Bush administration pushes "pay for performance" arrangements with various health care providers in an effort to publicize their performance and link Medicare payment to quality. And it mirrors efforts in the private sector, where consumer groups, insurance companies and large employers who pay for health care are demanding more information on the quality of care.

Tuesday, February 21, 2006

WA: Compromise emerges on medical-malpractice rules

From The Olympian:

Washington’s medical-­malpractice insurance war appears to be over — for now.

Gov. Chris Gregoire stood beside members of the state’s medical, legal and malpractice insurance establishments Monday to declare a breakthrough agreement in the state’s four-year battle over medical malpractice insurance and its cost to doctors.

The compromise announced Monday includes protections for doctors so that medical personnel can apologize to victims or family members without fear that admissions of fault will be used in direct evidence in malpractice lawsuits.

The deal also includes a new requirement that malpractice insurance rate increases be reviewed by state Insurance Commissioner Mike Kreidler before taking effect. But the compromise drops a three-strikes-you’re-out rule that trial lawyers once sought for offending doctors.

Cell Phone Bans in Hospitals - Invalid?

From USA Today:

According to an informal survey cited by the American Society for health care Engineering, about one-quarter of all hospitals ban cellphones entirely, half ban them from patient care areas, and the remaining quarter have no ban.

The bans go back to early reports from the 1980s that turning on a cellphone could turn off a ventilator or disrupt monitoring equipment.

But in surveying the engineering and medical literature on the topic, the researchers found that most incidents were single-case reports rather than widespread problems.

Modern digital cellphones use much less power than older analog models. And in 1979, the Food and Drug Administration created guidelines for shielding electronic medical devices, the paper notes.

By 1999, the Emergency Care Research Institute, a prominent private hospital advisory group, had updated its recommendations to allow the use of cellphones when quick clinical communication was needed.

Injuries spike amid Dutch dart craze

From CNN.com

A wave of international victories for Dutch darts players has prompted an increase in the number of injuries as people take up the game at home, according to the Dutch consumer safety association.

Over-eagerness caused most of the injuries, said a spokeswoman for the group, with players hurling their darts before opponents had finished retrieving their own. Poorly hung dartboards also posed problems.

"Often the board falls down on someone's foot or worse on someone's head," she added.

About 120 people are admitted to hospitals each year with injuries sustained during darts, with pierced fingers and wrists most common. Eye injuries were rare, the association said.

California execution delayed as doctors walk out

From CNN.com

The execution of a convicted killer was postponed early Tuesday after two anesthesiologists refused for ethical reasons to take part, renewing the long-running debate over what role doctors may play in the death chamber.

Michael Morales, 46, was supposed to die by lethal injection at 12:01 a.m. But the execution was put off until at least Tuesday night after the anesthesiologists objected that they might have to advise the executioner if the inmate woke up or appeared to suffer pain.

"Any such intervention would clearly be medically unethical," the doctors, whose identities were not released, said in a statement. "As a result, we have withdrawn from participation in this current process."

Monday, February 20, 2006

Trauma Centre - Under the Knife

From the Irish Developer Network:

A steady hand will be required as life and death decisions are laced firmly in your palm when Trauma Centre: Under The Knife launches on the Nintendo DS across Europe on 28th April 2006.

Become the next emergency room super-star as you take on the role of rookie doctor Derek Stiles in Trauma Centre: Under The Knife, from Publisher and Developer Atlus, Co. After being emerged into a dramatic and exciting storyline, players must guide Dr Stiles through a series of operations, learning new skills and talents along the way.

Set in Hope Hospital, Bay Dr Stiles must learn to cope under pressure as he gets to grip with basic surgery. After getting a few operations under his belt his mentors realise Dr Stiles is no ordinary doctor, but possesses a gift known in medical circles as the 'Healing Touch', a skill only possessed by a few top doctors, this special ability allows you to slow down time and perform miracles. Players must now utilise all the speed and concentration they can muster to master Stiles fantastic ability and save lives.

As rumours of his talent spread, Dr Stiles is scouted by Caduceus, an arm of the World Health Organisation responsible for being at the forefront of modern medicine and disease prevention. He is asked to help combat and eradicate diseases such as GUILT (Gangliated Utophin Imuno Latency Toxin), a disease that is thought to be spread by a medical terrorist group based in Africa, and save the world.

Bruce Willis Appreciates Emergency Workers

From Star Pulse (emphasis added):

Bruce Willis is championing a new initiative to provide emergency workers with better pay, and he believes starring as policemen adds weight to their campaign. The star jumps at the chance to plays cops in action films because he wants Americans to realize the harsh realitites of their everyday life.

He says, "I have a strong affinity towards working class people. I believe that any job that requires you to possibly get shot at or get shot dead, you should be paid hundreds of thousands of dollars for. These guys (cops) don't get paid anything, yet they go out there and do it. There are not a lot of them out there, and they are the last line between us and the wolves and the chaos that's out in the world. All these guys - cops, EMT workers, men and women, emergency room doctors and nurses - have to see horrific things. There should be thousands of films done about these guys. And they should get paid more money, a lot more money."

tPA for CVA

From Forbes:

"The number of acute stroke victims who are given tPA is very low -- 94 to 97 percent of stroke patients do not get the drug," said Smith, associate director of acute stroke services at Massachusetts General.

Approximately 700,000 people suffer a stroke every year, and it is the leading cause of serious, long-term disability in the United States, according to the American Heart Association. Its incidence rises sharply with age, from approximately 3 percent of those aged 55 to 64, to 6 percent of those between 65 to 74, to 12 percent of those over 75.

Tissue plasminogen activator (tPA) is a very effective clot-busting drug that can result in a dramatic reversal of stroke symptoms. It's approved for use in certain patients having a heart attack or stroke, and works by dissolving blood clots, which cause most heart attacks and strokes. It was approved by the U.S. Food and Drug Administration for treating strokes almost 10 years ago, but is still not given to most stroke victims who could benefit from it.

Saturday, February 18, 2006

ER, Olympics Version

From the NY Times:

The emergency room at the Centro Traumatologico Ortopedico in Turin, Italy, has been jammed lately. Practically every day, choppers have come chattering in from the Olympic luge run or the downhill courses, bearing the latest victims of wipeouts, wall-smacks and rollovers

Illegal Parking

From PJStar.com (the page featured an ad for Methodist Hospital when I viewed it, ironic, eh?):

Three parking tickets and a tow-away sticker had been placed on the sport utility vehicle in which a dead man's body was found last week.

Peoria police confirmed someone in the parking-enforcement division had issued the tickets and sticker to the SUV, which was parked illegally on Hamilton Boulevard near Methodist Medical Center.

The ticket writer did not see the body of Michael T. Hudson, a 46-year-old Decatur man reported missing Feb. 6, inside the black Mercedes.

His body was discovered in the back seat Feb. 9, when someone walked by and noticed a foot against the passenger-side, backseat window.

"A passer-by got up close enough and saw a (boot) pressed against a window and notified hospital security," Peoria police spokeswoman Ann Ruggles said. "(Hospital security) decided to wake the person up, and it wasn't working. They backed off and called police."

Conumer Satisfaction Scores = "Least Useful Information"

From the Washington Post (via Medlaw and Symtym):

In their quest for better health care, America's seniors have been scrutinizing report cards that grade Medicare's managed-care plans. But researchers worry that patients are being enticed by fancy waiting rooms, friendly receptionists and convenient parking garages rather than the best care providers.

That's based on an analysis by the National Bureau of Economic Research that suggests patients may be acting upon the least useful information, namely consumer satisfaction scores.

Although the report cards include health quality data, such as how many women in a plan received mammograms or whether diabetics were receiving proper eye care, patients' feedback had the most impact on future sign-ups.

"It is surprising that satisfaction scores were included at all, and potentially disconcerting that consumers ignored an alternative, objective measure of quality that was also provided," the authors wrote.

Friday, February 17, 2006

Two Studies Document Ambulance Diversion Problem

From an Annals of Emergency Medicine (ACEP) Press Release:

Two new studies published online by the Annals of Emergency Medicine document the extent of ambulance diversions signaling a lack of capacity in the emergency medical care system. One study is national in scope, while the other looks at the problem on the local level, but both uncover clues about the causes and characteristics of ambulance diversion that could help policymakers address the problem.

Centers for Disease Control and Prevention (CDC) researchers, in the first national study of ambulance diversions, found about one ambulance in the United States is diverted every minute from its originally intended emergency department because it was overcrowded and could not safely care for another sick or injured patient. The research is based on the 2003 National Hospital Ambulatory Medical Care Survey, an annual probability sample survey of U.S. hospital emergency departments and outpatient departments.

About 16.2 million patients arrived by ambulance to emergency departments in 2003, which represent 14 percent of the total emergency department visits made that year, according to the CDC. Of those visits, seniors comprised nearly 40 percent, the largest group transported by ambulance to emergency departments.

"Considering the biggest users of ambulance services are people over age 65, and the number of seniors is expected to substantially increase over the next decade, ambulance diversion could disproportionately affect this age group," said the study’s lead author Catharine W. Burt, Ed.D., with the CDC’s National Center for Health Statistics in Hyattsville, Maryland

Non-English speakers find ERs hard to reach

From SFGate.com:

People who speak limited English do not receive adequate access to emergency room services in Alameda County, and that compromises the quality of care they receive and can aggravate their health problems, according to a study released Wednesday.

More than half of testers speaking a language other than English were hung up on, rather than connected to a staff member or interpreter who could help them, according to the Discrimination Research Center.

Researchers said the results show the importance of hiring a multilingual workforce. Center director Monique Morris said telephone audits provide important data to replace largely anecdotal information available until now on language access.

"This is to help support the work of advocates and people who have long been working on language access, by providing empirical data," she said.

The center measured the availability of language services by conducting 551 tests at 12 Alameda County hospitals last year in English, Vietnamese, Cantonese, Tagalog and Spanish.

None of the testers who called speaking English were disconnected or hung up on, and the tester was never put on hold longer than 10 minutes.

Symptoms used in the scripts were serious enough to warrant medical attention but not urgent enough to trigger an ambulance to be dispatched. They included high fever with shortness of breath, high fever with a bad headache, and "bad diarrhea."

About 62 percent of calls in Vietnamese resulted in a hang-up or disconnection, and half the time, the hospital staff did not connect the caller to a Vietnamese speaker. Calls placed in Cantonese resulted in a hang-up 63 percent of the time

Man accused of biting off girlfriend's nose, swallowing it

From KTEN.com (Tulsa, OK):

A man shocks those gathered for a family meal by allegedly biting off the nose of his girlfriend.

Tulsa police say the victim, Jody Bennett, came out of a back room of a north Tulsa residence with a napkin over her face and told others that her boyfriend had bitten her nose.

Ambulance personnel who were summoned saw that Bennett's nose was bitten off where it should have been attached to her face and reportedly called the police.

Police spokesman Corporal Larry Edwards says officers looked for the nose but couldn't find it and believe he may have swallowed it.

Bennett was taken to Saint John Medical Center, where police had talked to emergency room personnel about pumping Hill's stomach in an attempt to find the nose.

Police Corporal Shane Tuell says doctors told them that would be futile because the nose is composed primarily of cartilage and soft tissue, and Hill's stomach acid would've dissolved it quickly.

Hill -- who denies the assault -- was booked into jail on complaints of aggravated assault and battery, resisting arrest and destroying evidence.

Sleep on it

From the BBC:

Dutch study suggests complex decisions like buying a car can be better made when the unconscious mind is left to churn through the options.

This is because people can only focus on a limited amount of information, the study in the journal Science suggests.

The conscious brain should be reserved for simple choices like picking between towels and shampoos, the team said.

Psychologists from the University of Amsterdam in the Netherlands divided their participants into two groups and devised a series of experiments to test a theory on "deliberation without attention".

One group was given four minutes to pick a favourite car from a list having weighed up four attributes including fuel consumption and legroom.

The other group was given a series of puzzles to keep their conscious selves busy before making a decision.

The conscious thought group managed to pick the best car based on four aspects around 55% of the time, while the unconscious thought group only chose the right one 40% of the time.

But when the experiment was made more complex by bringing in 12 attributes to weigh up, the conscious thought group's success rate fell to around 23% as opposed to nearly 60% for the unconscious thought group.

Thursday, February 09, 2006

EM Podcast

I thought this might be interesting - a podcast by an Emergency Medicine Physician:

Another Night Shift

Program to curb expensive repeat emergency room visits

From the Kearney (NE) Hub:

A program to reduce emergency room visits by repeat patients who drain the health system and taxpayer dollars has seen strong results in the past four months.

In a year, the 35 patients who have since enrolled in the free Lincoln ED Connections program made a total of 377 visits to Lincoln emergency departments. Twelve who made the most visits received $231,869 in unreimbursed care for that time period.

On Tuesday, officials from the city’s general hospitals — BryanLGH Medical Centers west and east and Saint Elizabeth Regional Medical Center — came together to praise the program and its success.

The program began in October and is paid for by a local grant of $300,000.

Over a three-month period, the rate of visits by those frequent patients has been reduced by about two-thirds.

Access to Emergency Medical Services Act

Ladies Home Journal, ACEP’s media partner for the Rally at the U.S. Capitol published an update in the January issue, promoting a petition to the public in support of the “Access to Emergency Medical Services Act” (HR 3875).  If sufficient numbers of the public respond, ACEP and Ladies Home Journal will hold a press event at the Capitol, bringing the petitions to Congress.  Please send this link to everyone you know – family, friends — and ask them to send a message to Congress and pass it on.

[ http://www.lhj.com/lhj/story.jhtml?storyid=/templatedata/lhj/story/data/1134668723937.xml ]

Tuesday, February 07, 2006

More on Ambulance Diversion

From the Hawaii Channel:

A national study indicates that an ambulance is diverted every minute, on average, to a different hospital because emergency rooms in the U.S. are so overcrowded.

The study did not measure how the delays in getting to hospitals affected patients' survival, but experts said it could not have been for the better.

Catharine Burt of the National Center for Health Statistics is the study's lead author. She said that whether the delay is two minutes or 15, that's going to have some impact.

About 500,000 ambulances were diverted from their original destinations because the receiving hospitals' emergency departments were too overcrowded, the survey data from 2003 indicated.

Of the more than 16 million patients who arrive at an emergency room by ambulance, 70 percent need critical care within the hour.

Ambulances are diverted when a hospital's emergency department closes its doors to incoming patients and directs traffic to other hospitals.

The study is being published in the journal Annals of Emergency Medicine.

AED Save in Texarkana

From the Texarkana Gazette (emphasis added - seven!):

Lionell Joseph holds the distinguished honor of being able to tell a story that few people ever the get the chance to tell—the story of the day he died.

Joseph swears he was surrounded by angels that day.

But he isn’t talking about angels from the realm of heaven. The angels he speaks of are the earth-bound variety, otherwise known as his coworkers at International Paper Mill in Domino, Texas. Joseph, 55, says if it weren’t for them, he wouldn’t be here today.

It was close to the 11 p.m. shift change at the IP mill in Domino, Texas, when coworkers found Lionell Joseph laid out and unresponsive in the pulp wood control room.

Someone sounded the emergency alarm which immediately calls for help from the mill’s Medical Emergency Response Team (MERT), setting into motion a chain of events that eventually saved Lionell’s life.

“I walked into work and I heard the alarm go off,” said Wiley Clark, an IP employee and one of the first to arrive on the scene where Lionell lay dying. “He was turning blue. He had no pulse and he wasn’t breathing. We initiated CPR with an AED (artificial external defibrillator) ... which was right there.”

Though he had received hours of training to teach him how to deal with a situation like this, the reality of being the link between life and death for a man that he liked and respected weighed heavily on Clark’s shoulders.

“I was nervous and scared,” Clark said of his role in saving Joseph’s life. “But I took a deep breath and I knew what we had to do.”

Clark and another coworker began CPR immediately. By the time the medical response team arrived on the scene, the two already had Joseph hooked up to one of seven AEDs located across IP’s 1,300 acre mill.

Symtym Comments on Ambulance Diversion Studies

From Symtym (an ED Physician, law student / blogger):

The single greatest real threat to the U.S. healthcare system is the inability to surge capacity—almost all urban settings nationwide are affected. Present healthcare funding and "competition" has stripped any ability to surge capacity—leaving our healthcare system truly lean and mean. Contrary to the old adage about the "bird-in-hand," our attention and our ambulances are all diverted. Ambulances are diverted solely because that is the only surge in capacity the hospitals can control. Plain and simple, diversions are a sign of diseased hospitals—stricken with the disease of too little beds, too little staff, or a combination of both. Like ambulances, and the EMS system in general, the Emergency Department (ED) becomes the next stricken victim of this true nosocomial disease.

Those first stricken, like victims of scourges past, are perceived as the cause and are punished for their shortcomings. As in ages past, the truth is much more subtle and pervasive—ambulance, EMS, and EDs are just low hanging fruit on the diseased trees. Ambulances will cease to be diverted only when EDs cease to close, and EDs will cease to close only when the hospitals are cured of their insidious inability to meet healthcare demands.

One final point of clarity, the term should never be ambulance diversions or EMS diversions or ED diversions—it should be hospital diversions, because it is far more preferable and logical to name a disease after its cause, instead of its victims…else, what should we call the "bird flu?"

Monday, February 06, 2006

Utah Tort Reform

From the Salt Lake (City) Tribune:

Bonnie and John Robbins lost their 13-month-old daughter, Rubie, two years ago to meningitis after she was allegedly misdiagnosed in the emergency room at Primary Children's Medical Center.

Now, the two warn that Utah victims of medical mistakes could have a harder time finding a lawyer to represent them if state lawmakers pass HB270.

The bill would make it more difficult to win malpractice lawsuits against emergency health care providers. Sponsored by Sheryl Allen, R-Bountiful, Emergency Medical Service Provider Tort Reform would amend state law to give such medical personnel a higher level of protection against litigation than other health care providers.

Under the bill, the standard for determining negligence by emergency care workers would be upgraded from a "preponderance of the evidence" to "clear and convincing" evidence.

Lawmakers passed the bill on to the full House earlier this week after two hours of emotional testimony from patients' families, doctors, victims' advocates and lawyers.

Saturday, February 04, 2006

Device allows for remote stroke diagnosis

Sounds like a webcam...

From the Rocky Mountain News:

A new camera system will allow neurologists in Denver to zoom in on the faces and limbs of patients in outlying Colorado hospitals to determine whether they've had a stroke.

The system could save lives because people lose 1.9 million brain cells every minute during a stroke, so the sooner there is a correct diagnosis, the sooner anti-clogging medication can be given, neurologists say.

The Colorado Digital Online Consultant, or CO-DOC, is coordinated by the Colorado Neurological Institute, a nonprofit organization of neurologists that applies for grants and advocates for better access to neurological treatment. Program partners are Swedish Medical Center in Englewood and Blue Sky Neurology.

It soon will be operating between metro Denver and the Vail Valley Medical Center. Swedish and CNI have applied for a state grant so remote machines can be installed elsewhere in Colorado.

"We can actually operate it from anywhere that has Internet access - the home, the office or at Swedish," said Dr. Chris Fanale of CNI.

Here's how the system works:

A patient checks in to a clinic or emergency room of a small hospital with symptoms that may or may not indicate a stroke.

Doctors and nurses who are not experts in neurology may be reluctant to jump to a conclusion because the best anti-clogging medication, TPA, has dangerous side effects that can include fatal bleeding.

So the hospital or clinic calls Swedish Medical Center or the neurologist on duty.

The neurologist plugs into a laptop with special software. A small Web camera is pointed at the doctor's face. On the other end, a larger camera is pointed at the patient's bed. The system allows patient and doctor to see and talk to each other in real time.

More patients asked to pay first

From the News Observer, via Symtym:

The next time you go in for care at UNC Hospitals or any of its outpatient clinics, don't forget your wallet.
Hospital workers are beginning to ask patients who come in for non-emergency care to pay their portion of the bill up front, usually when they check in for medical appointments.

Some may balk at paying for treatment they have yet to receive, but many hospitals say it's necessary because too many patients don't pay their share. Unpaid bills have mounted in recent years, and hospital administrators worry that will only worsen as health insurance becomes less generous and patients become responsible for more of their own medical bills. Patient fees now frequently make up a quarter or more of hospitals' total reimbursement for some services.

Friday, February 03, 2006

Congress Halts Medicare Cut: Iowa Specifics

From the Iowa Medical Society:
On February 1, Congress voted to halt a cut in Medicare reimbursement that would have decreased Iowa physician reimbursement in 2006 by $24 million. Instead of a 4.4 percent cut, reimbursement will be frozen at 2005 rates

Medicare Payments Frozen at 2005 Levels

From an ACEP press release.

The House of Representatives reversed a month-long reduction in Medicare physician payments Wednesday night when it passed a budget reconciliation bill that will freeze payments at the 2005 levels. The bill, which is now awaiting the President's signature, narrowly passed by a 216-214 vote and overturns the 4.4 percent reduction in payments that was dictated by the flawed sustainable growth rate formula.

“Thank you to those emergency physicians who called, e-mailed or wrote their representatives and senators to urge them to take action to prevent the Medicare cuts,” said Frederick C. Blum, MD, ACEP President.

“Our voice was heard on this issue in the midst of many groups who opposed passage of this legislation. When we work together, ACEP can accomplish big things,” he said.

The Centers for Medicare and Medicaid Services (CMS) has advised that the claims adjustment process will take several weeks but physicians will not have to resubmit claims.

In addition, CMS will reopen the 45-day period in which physicians may change their 2006 Medicare participation status. Changes will be retroactive to January 1, and claims will be adjusted to reflect the change in status.

Emergency physicians will continue to press Congress for changes to the underlying problem in the flawed sustainable growth rate formula. Look for more opportunities to take action soon.

Heart Disease and Women

From CNN:

U.S. women still do not fully understand their high risk of heart disease and are confused by reports that suggest being overweight and inactive are not really that dangerous, the American Heart Association said.

Statistics released on Tuesday show 483,800 American women died from heart disease and stroke in 2003, the latest year for which detailed statistics are available.

Six million women had coronary heart disease and 3.1 million had strokes, the association said in a special issue of its journal Circulation.

"That's more lives than were claimed by the next five leading causes of death combined: cancer, chronic obstructive pulmonary disease, Alzheimer's, diabetes and accidents," the Heart Association said.

But only 55 percent of 1,008 women surveyed knew that heart disease is the No. 1 killer of U.S. women over the age of 25 -- although that is up from 30 percent in 1997.

Nice stethoscope. Now, learn to use it

From the LA Times, via Symtym:

The stethoscope may be an icon of the medical profession. But as a tool of the trade, many veteran physicians fear it is becoming a useless prop of doctorhood.

As physicians rely on more accurate and expensive tests of cardiac function, including echocardiography, the art of listening to the heart has fallen on hard times. In recent years, a spate of studies has shown that as few as 20% of new doctors and 40% of practicing primary-care doctors can discern the difference between a healthy and a sick heart just by listening to the chorus of whooshes, lub-dubs, gallops and rubs that compose the distinctive music of the human heart.

But a handful of veteran physicians are struggling to revive the dying art of cardiac auscultation, or examining the heart with a stethoscope. They may fault the advance of technology for what they believe is a decline in doctors' skills, but these defenders of the stethoscope are no Luddites. They are banking on computer-generated heart sounds, virtual patients, CD-ROMs and that ever-present student friend the iPod to help a new generation of doctors overcome what Dr. Michael Barrett of Temple University recently called their "woeful lack of stethoscope skills."

By honing those skills in the next generation, defenders of the stethoscope hope to shore up physicians' first line of diagnosis, to stem the growth of healthcare costs and to preserve the purpose and integrity of one of medicine's most revered rituals — the laying on of hands (not to mention hard metal) to treat patients

Wednesday, February 01, 2006

Anger Common Before Injury

From the Seattle Post-Intelligencer

Guys, watch out the next time anger threatens to overtake common sense. You could wind up in the hospital. That's the conclusion of a University of Missouri-Columbia researcher who found that anger increased the risk of injury, especially for men, after interviewing more than 2,400 emergency-room patients at three Missouri hospitals.

The study, published Tuesday in the Annals of Family Medicine journal, found that people who described themselves as feeling "hostile" before getting hurt faced twice the risk of injury. And compared to women, men were more likely to injure themselves when angry.

"When we men start to get angry, maybe we need to take a step back," said Dan Vinson, a professor of family and community medicine and the study's primary author.

Surprisingly, Vinson said he found no statistical connection between self-descriptions of anger and traffic accidents - a finding that suggests road rage may be more of an internal state of mind rather than an outward behavior with violent consequences.

Mobile Phones Increase Safety Through Enhanced Communication

From Medgadget:

Using mobile telephones in hospitals reduces the error rate in medical care because of more timely communication and rarely causes electronic magnetic interference, Yale School of Medicine researchers report this month.

The study published in February's Anesthesia & Analgesia is believed to be the first to investigate whether use of cell phones by medical personnel has a beneficial impact on safety. It was based on 4,018 responses from attendees at the 2003 meeting of the American Society of Anesthesiologists.

Of those anesthesiologists who participated in the survey, 65 percent reported using pagers as their primary mode of communications and 17 percent said they used cellular telephones. Forty percent of respondents who use pagers reported delays in communications, compared to 31 percent of cellular telephone users.

The senior author, Keith Ruskin, M.D., associate professor in the Departments of Anesthesiology and Neurosurgery, said the electronic interference from mobile telephone was a problem in the past because of older telemetry equipment and analog cell phones.

"The new digital cell phones used much higher power and operate at a different frequency," Ruskin said. "The small risks of electromagnetic interference between mobile telephones and medical devices should be weighed against the potential benefits of improved communication."

Health Care Worker's Right to Refuse?

From the Washington Post, via Symtym:

More than a dozen states are considering new laws to protect health workers who do not want to provide care that conflicts with their personal beliefs, a surge of legislation that reflects the intensifying tension between asserting individual religious values and defending patients' rights.

About half of the proposals would shield pharmacists who refuse to fill prescriptions for birth control and "morning-after" pills because they believe the drugs cause abortions. But many are far broader measures that would shelter a doctor, nurse, aide, technician or other employee who objects to any therapy. That might include in-vitro fertilization, physician-assisted suicide, embryonic stem cells and perhaps even providing treatment to gays and lesbians.